Governance in Southeast Asia: Issues and Options

This paper attempts to analyze governance systems in Southeast Asia and proposes some policy suggestions that can improve governance practices in the region. It also discusses the links between governance and official development assistance (ODA) and the role of the Japan Bank for International Cooperation. To put the discussion on governance systems in a proper context, the paper discusses the governance and growth nexus in Southeast Asia; describes the operating governance systems in Southeast Asia; analyzes economic governance, more specifically in the areas of economic management and growth, revenue generation, social spending, access to services, cost of doing business, and corporate governance; and examines political governance, focusing on the rule of law and judicial independence, conflict management, and voice participation.governance, development program, corruption

Governance in Southeast Asia: Issues and Options

This paper attempts to analyze governance systems in Southeast Asia and proposes some policy suggestions that can improve governance practices in the region. To put the discussion on governance systems in a proper context, the paper discusses the governance and growth nexus in Southeast Asia; describes the operating governance systems in Southeast Asia; analyzes economic governance, more specifically in the areas of economic management and growth, revenue generation, social spending, access to services, cost of doing business, and corporate governance; and examines political governance focusing on the rule of law and judicial independence, conflict management, and voice participation.governance, development program, corruption

Governance in Southeast Asia: Issues and Options

This paper attempts to analyze governance systems in Southeast Asia and proposes some policy suggestions that can improve governance practices in the region. To put the discussion on governance systems in a proper context, the paper discusses the governance and growth nexus in Southeast Asia; describes the operating governance systems in Southeast Asia; analyzes economic governance, more specifically in the areas of economic management and growth, revenue generation, social spending, access to services, cost of doing business, and corporate governance; and examines political governance focusing on the rule of law and judicial independence, conflict management, and voice participation.governance, development program, corruption

Mainstreaming human security in the Philippines: options and prospects for non-state actors in light of the "ASEAN way"

"Der 'ASEAN Way', der konsensuelle Entscheidungsprozesse, informelle Strukturen und Prozesse sowie das Prinzip der Nichteinmischung in die inneren Angelegenheiten der Mitgliedstaaten betont, hat direkte Auswirkungen auf die Weiterentwicklung menschlicher Sicherheit auf den Philippinen. Innerhalb dieses Rahmens erweiterte ASEAN die sicherheitspolitische Agenda um Probleme wie Armut, Epidemien, Nahrungsmittelsicherheit, Menschenrechte und Klimawandel. Es erfolgte jedoch keine Vertiefung des Sicherheitsbegriffs durch einen Fokuswechsel vom Staat hin zu Individuen und Gruppen - und das obwohl der 'ASEAN Way' ausreichend Operationalisierungsspielraum für normative nicht-staatliche Sekuritisierung böte. Philippinische NGOs beteiligen sich an politischen Entscheidungsprozessen, beeinflussen und vermitteln eigene politisch relevante Werte und Normen, und stellen sogar eigene Regeln auf. Für die im Kontext eines 'weichen' staatlichen Rahmens agierende philippinische Regierung wären daher die am meisten angemessenen Aufgaben bei der Verwirklichung der Agenda menschlicher Sicherheit die Stärkung der vorhandenen internationalen Strukturen, die Erweiterung des demokratischen Spielraums für nicht-staatliche Akteure sowie der Beitritt zu zwischenstaatlichen Regime und quasi-diplomatischen Arrangements. Damit könnten Transaktionskosten gesenkt und die Reziprozität innerhalb ASEANs gefördert werden." (Autorenreferat)"Progress in human security in the Philippines is influenced by the 'ASEAN Way', which underscores consensual approach to decision-making, informal structures and processes, and the principle of non-interference in member-countries' internal affairs. Along these lines, ASEAN broadened the agenda of security to encompass problems like poverty, epidemics, food security, human rights, and climate change, but failed to deepen security from a focus on the state to a focus on human individuals and communities. Yet the 'ASEAN Way' offers enough tolerance for 'operationalizing' possibilities for normative non-state securitization. Philippine NGOs have intervened in the decision-making process, shaped and disseminated politically relevant values and norms, and have taken the initiative to set rules themselves. For the Philippine government laboring under 'soft state' conditions, the most appropriate role based on a human security agenda would be to strengthen existing institutional structures, expand the democratic space for non-state actors, and join inter-state regimes and quasi-diplomatic arrangements, thereby reducing transaction costs and facilitating reciprocity within ASEAN." (author's abstract

Dependencia funcional, deterioro cognitivo y características de la marcha en adultos mayores con enfermedades crónicas

Objetivo: Identificar el nivel y relación de dependencia funcional (DF), deterioro cognitivo (DC) y características de la marcha en adultos mayores (AM) con enfermedades crónicas, habitantes del área metropolitana de Saltillo, Coahuila. Método: Diseño descriptivo correlacional. Muestra constituida por 105 AM de 60 años o más, usuarios de los Centros de Atención e Integración Familiar (CAIF). El tamaño de la muestra se determinó a través del paquete estadístico nQuery Advisor 7.0 considerando análisis de correlación bivariada, nivel de significancia de 0.5 y potencia del 95%. El muestreo fue por conveniencia. La recolección de datos se realizó a través de una cédula de datos socio-demográficas conjuntamente con cuatro instrumentos: para DF 1. Actividades Básicas de la Vida Diaria (AVD) y 2. Actividades Instrumentales de la Vida Diaria (AIVD); para DC 3. Mini Mental State Examination MMS-E; para las características de la marcha, 4. Sistema para Análisis de Marcha GaitRite ©, alphas de 0.730, 0.765, 0.720 y 0.811, respectivamente. Resultados. La edad promedio de los AM participantes es de 75 años (X = 75 ± 6) y escolaridad de 5 años (X = 5 ± 3). La mayor parte son mujeres (81.9%); que viven sin pareja (74.3%) y reportan alguna enfermedad crónico-degenerativa (65%) como Diabetes, 32.4%; Hipertensión, 61% y Enfermedades Articulares, 42%. La prevalencia de: dependencia severa en ABVD 5.7% y AIVD 21.9 %; DC 24 %; Los AM con mayor edad y menor escolaridad, reportan mayor grado de DC (r= .251; p<.05; r= -.259; p<.05, respectivamente) y dependencia para realizar ABVD (r=.297; p<.05) y AIVD (r=.351; p<.05); Por lo menos, el 30% de AM presentabó dificultades para mantener el equilibrio. Además, el 60% presentó dificultades para sentarse porque tienen problemas al medir la distancia entre su propio cuerpo y la silla, caen en la silla o se apoye en él con movimientos inseguros. 29% presentaba dificultades para elevar su pie derecho completamente. Discusión y Conclusiones. Los resultados de este estudio confirman lo que la literatura reporta acerca de la prevalencia y asociación de DF, DC y presencia de enfermedades crónicas características del AM como Diabetes e Hipertensión. Es necesario profundizar en el análisis de este estudio incorporando mediciones acerca del tiempo de diagnóstico de la enfermedad crónica, co-morbilidad, síntomas de depresión y diferencias de género, entre otros aspectos. También los factores asociados a la problemática de la marcha. Para el profesional de Enfermería, la continuidad de este fenómeno de estudio, fortalecerá el cuerpo de conocimientos disciplinares y la atención a las complejas necesidades de cuidado a la salud que demanda este segmento de la población. Palabras Clave: Adulto Mayor, Dependencia Funcional, Deterioro Cognitivo, Marcha

Targeting Cx43 and N-Cadherin, Which Are Abnormally Upregulated in Venous Leg Ulcers, Influences Migration, Adhesion and Activation of Rho GTPases

Venous leg ulcers can be very hard to heal and represent a significant medical need with no effective therapeutic treatment currently available

Personality profiles of cultures: aggregate personality traits

Personality profiles of cultures can be operationalized as the mean trait levels of culture members. College students from 51 cultures rated an individual from their country whom they knew well (N = 12, 156). Aggregate scores on Revised NEO Personality Inventory scales generalized across age and gender groups, approximated the individual-level Five-Factor Model, and correlated with aggregate self-report personality scores and other culture-level variables. Results were not attributable to national differences in economic development or to acquiescence. Geographical differences in scale variances and mean levels were replicated, with Europeans and Americans generally scoring higher in Extraversion than Asians and Africans. Findings support the rough scalar equivalence of NEO-PI-R factors and facets across cultures, and suggest that aggregate personality profiles provide insight into cultural differences

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill &amp; Melinda Gates Foundation